Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056.012780 | IL |
N | 225XL0004X | Low Vision |
NPI | 1215407465 |
---|---|
Provider Name | Katrina Annalese Stratton |
First Address | Wheaton, IL 60187-3107 |
Second Address | Wheaton, IL 60187-3107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2018 |
Last Update Date | 30/11/2018 |